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Full text of "United States Navy Medical News Letter Vol. 44 No. 11, 11 December 1964"

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NAVMED P-3088 

Vol. 44 

Friday, 11 December 1964 

No. 11 



IMPORTANT— News Letter Renewal Notice Required 



Hemodialysis in the Management of Acute Renal 


Current Blood Banking Operations 


Antarctic Research Program 

Radioisotope Techniques and Nuclear Medicine 


Important Info for MSC Officers 

MSC Performance and Training 

New Publication — Color Photography 


Semi-Permanent Treatment of Fractured Incisors . 
88th Congress 

Home Fluoridator Costs Get Tax Bureau Blessing. 

National Institute of Dental Research 

Diagnosis and Treatment of Bacterial Endocarditis. 
The Use of Fast Films in Intra-Oral 


Personnel and Professional Notes 




Sanitation and Pest Control in Disaster Areas 

Psittacosis Surveillance 

Food Poisoning 

Know Your World 

Education Checks Tattoo Hazard 

Fee Schedule of 2000 Years Ago 


American Board Certifications of Reserve Officers 


Advanced Course in Nuclear Science 

New Organizational Flag Presented to AFIP 

Navy Commendation Medal Awarded to LT William 
A. Stone MC USN 

USN Medical Officers Present Papers at West Coast 

Research Reserve Seminar 

Standards of Conduct Directive Modified by DoD — 







United States Navy 

Vol. 44 

Friday, II December 1964 

No. 11 

Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A, Kline, Managing Editor 


Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 


The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 

ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 


FRONT COVER: Another view of the U.S. Naval Hospital, San Diego, California, showing the main Adminis- 
tration Building in the center. Building 2 on the left and Building 5 on the right^ — only a small portion of this great 
hospital complex (see cover and inside front cover legend of Vol 44, No. 10, Med News Ltr of 27 Nov 1964). 

The training received by a typical intern at this hospital during a recent year, showed that he delivered 188 
obstetrical cases, performed 132 and assisted at 93 surgical operations, administered 91 general and spinal anesthetics, 
and attended 40 autopsies. 

Residency programs in the specialties of Anesthesiology, Cardiovascular Disease, Dermatology, Medicine, Ob- 
stetrics and Gynecology, Ophthalmology, Otolaryngology, Pathology, Pediatrics, Radiology, Surgery, Thoracic Sur- 
gery, and Urology are conducted at this hospital. 

(Photo submitted by Mr. John Stringer, Head of the Medical Photography Laboratory, U.S. Naval Medical 
School, NNMC, Bethesda, Md. 20014)— Editor 

The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 


Hemodialysis in the Management of Acute Renal Failure 

CAPT Paul D. Doolan MC USN, Director, Clinical Investigation Department, U. S. 
Naval Medical Research Institute, Bethesda, Md. 

Hemodialysis eflfectively removes retained metabo- 
lites, corrects acid base imbalances, cures potassium 
intoxication, and with appropriate modifications, 
quickly relieves the burden imposed by overhydration.^ 
In short, artificial kidneys save lives and represent one 
of the most important therapeutic advances of our time. 
All this being so, hemodialysis is but a component in 
the total care of the patient, and as such, must be 
considered within the full context of the problem. The 
problem at hand is most challenging for all of us who 
wear the uniform, for our mandate is to heal the most 
desperately injured under less than optimum circum- 

The bias contained in the following comments lies 
in the direction of insisting on a level of medical sup- 
port some may think unrealistic in a theater of war. 
It is folly to quibble about dialytic techniques if no 
survivors arrive due to inadequate supplies of blood, 
a rapidly changing front or enemy control of the air. 
This is true but one must still decide on what is needed 
before anything else including compromises can be 
discussed. Adequate treatment of posttraumatic renal 
failure demands, for example, a minimum of profes- 
sional and technical capabilities embodied in the form 
of a renal center. If such a renal center cannot be pro- 
vided then the plight of the majority of these patients 
is hopeless and it matters little whether they are at- 
tended by medical officers or actuaries. 

The clinical expression of acute renal insufficiency is 
a function of three main forces; the nature of the 
precipitating cause, the intensity of the catabolic res- 
ponse; and the duration of the oliguria. Let the point 
be emphasized that in addition to these forces and some 
technical capabilities, successful management rests 
mainly on a series of correct judgment decisions. These 
decisions begin with the resuscitative effort, for the 
patient's clinical course and ultimate fate are frequently 
decided at this early stage. Has all the devitalized tissue 
been removed, should the leg be amputated, has hemo- 

• From Bureau of Medicine and Surgery, Navy Department, Research 
Task No. MR 005.12-1600.01, Presemed before the Section on 
Military Medicine of ihe American Medical Association Meeting in 
San Francisco, California on 21-25 June 1964. 

Stasis been achieved, what complications are peculiar to 
the specific tissue damaged and how are all these con- 
siderations influenced by the possible development of 
acute renal failure? These are the types of judgment 
decisions that must be made and they clearly indicate 
the nature of the nephrologist's dependence on his 
surgical colleagues. Their joint interest extends beyond 
these urgent matters for there is reason to believe that 
both the incidence of renal shutdown and the magni- 
tude of the catabolic response are related to the degree 
and extent of tissue damage.^ Less work has been 
devoted to the problem of the influence of uremia on 
the overall surgical response but certainly a cycle exists 
between initial and derivative forces. The summons 
to an integrated and sustained medico-surgical effort 
is clear. 

In so far as the renal failure is concerned the goa! 
must be to keep the patient as near normal as possible. 
This means instituting dialysis therapy very soon after 
the diagnosis has been established, using whatever tech- 
nique is best suited for the particular patient. Further, 
it commits one to the policy of frequent to semi-con- 
tinuous theray. Such intensive therapy has been made 
possible by the advent of silatic teflon blood-vessel 
cannulae which have a high reliability; the need for 
recannulation being something in the order of every 
sixth patient because of troubles on the venous end.^ 
A number of different dialyzers may be used. The two- 
layer Kiil dialyzer offers the advantage of requiring no 
more than 500 ml of priming blood, flow rates of up 
to 200 ml per minute are possible without a pump, it 
can be quickly assembled and the incidence of leaks 
during operation is extremely low.'^-^ The 350 liters of 
dialyzing solution required for a single day presents 
somewhat of a problem in that space is always at a 
premium and the refrigeration required represents an 
added encumbrance. The handling of the dialysate, 
cooled or warmed, recirculated or single pass is, how- 
ever, an area under active investigation and one in 
which adaptations and compromises may be made to 
suit particular circumstances.' Nonetheless, the over- 
riding advantage of this technique is that adequate 



therapy can be provided as a nursing procedure, thus 
enabling medical ofRcers to attend to the myriad of 
other important clinical problems. We are, of course, 
indebted to the Seattle group for much of the progress 
in this area.^'*"'''^'** 

Why go to these extremes and what evidence is 
there that it does any good? Mortality in posttraumatic 
renal failure is in excess of 60% when the patients 
are treated by specialists using modern techniques 
according to accepted criteria." The mortality is still 
higher in patients treated less completely. These poor 
survival rates are reason enough for further effort. 
No student of this problem has to my knowledge 
suggested that dialysis be used less frequently; rather 
the trend has been toward earlier and more frequent 
treatment. Teschan, in 1960, clearly analyzed the prob- 
lem and enunciated the important concept of prophy- 
lactic hemodialysis." The rationale, as I understand 
this concept, is that patients with posttraumatic renal 
failure are prone to develop anemia, infections, myo- 
sitis, impaired wound healing and a dreadful wasting 
that cannot be treated but may be prevented by inten- 
sive dialysis therapy. This hypothesis ignores mechan- 
isms but it enjoys the testimony of common sense and 
deserves testing. A sampling of the experience to date 
reveals that most investigators are encouraged. Muli- 
nari and Hegstrom in Seattle ^ and Parsons in Leeds ^° 
report mortality rates of 25 and 40 percent respectively 
which represent significant reductions in the post- 
traumatic group. Dr. Alwall in Lund ^^ who has a 
very large experience with posttraumatic renal failure 
treated with both conventional and intensive dialysis, 
reports, however, that mortality remains high and 
Easterling and Forland report that in the expanded 
experience at Brooke Army Medical Center the mor- 
tality was 64 percent.'^ These statistics are given 
because someone always asks for them and so they 
can now be used to serve either positive or negative 
prejudices. One need not enlarge on the difficulties 
inherent in any attempt at a meaningful statistical treat- 
ment of a multivariable continuum for which it may be 
impossible to obtain control groups and in which the 
data are compiled by investigators with differing sys- 
tematic biases but no pre-agreed upon definitions. 
What is more impressive is that the aforementioned in- 
vestigators as well as Drs. Brun in Copenhagen^'^ and 
Shaldon in London ^^ are unanimous in the opinion 
that intensive dialysis therapy unquestionably improves 
the well-being of the patient and facilitates overall 
management. This is a significant advance, since the 
possibilities with an alert and cooperative patient are 
much better than with one who is obtunded, agitated 
or depressed. With pulmonary complications being a 
major cause of death, the desirability of having a 
patient who can comply with the pulmonary prophyl- 
axis routine is obvious. Other things being equal, these 
patients can be ambulated more which restores or main- 
tains vascular tone, decreases the negative nitrogen 

balance, and prevents phlebothrombosis and decubitii. ( j 
Finally, a certain percentage of these patients are able 
to take a diet containing 30-50 gms of protein and 
several thousand calories. Beyond the value this has 
in preventing the distressing oral lesions which occur 
in a fair percentage of these patients, I am persuaded 
to believe that protein intake may have a salubrious 
effect of a more fundamental nature. Heretofore, most 
students of acute renal failure have felt that the cata- 
bolic response represented the wisdom of some higher 
authority, and since it could not be altered it had best 
never be tampered with. This case rests on the results 
of nitrogen balance studies which tell one something 
about a net effect and nothing about the thousands of 
component reactions. Must the influence of protein 
intake on say RNA turnover in the liver be qualitatively 
the same as on muscle protein? Is it not probable that 
the catabolic response may merge into a vicious cycle 
wherein deficient protein synthesis perpetuates con- 
tinued cataboHsm? Prophylactic dialysis in allowing 
patients to eat earlier may enable us to break or pre- 
vent this cycle. By offering food and disposal facilities 
simultaneously we continue to render homage to nature 
and at worst, our error will be one of inefficiency. 

In conclusion, let me state that the indications for 
hemodialysis are largely a function of the skill and 
facility with which the procedure can be accomplished. 
The advent of chronic vessel cannulation and passive 
flow low volume dialyzers extend new hope to the -^ 
patients with posttraumatic renal failure, for now they 
can be protected rather than rescued at the brink. 


1. MerriU, J.P.: The artificial kidney, N Engl J Med 246: 17, 

2. Balch, H.H., Meroney, W.H. and Sako, Y.: Observations on the 
the surgical care of patients with posttraumatic renal insuffi- 
ciency, Battle Casualties in Korea, Vol. IV, U.S. Army Medical 
Service Graduate School, Walter Reed Army Medical Center, 
Washington, D.C, Chap V. 

?. Mulinari, A.S. and Hegstrom, R.M. r Pumpless low temperature 
hemodialysis in the management of acute renal failure (in press), 
Symposium on Acute Renal Failure, Royal Free Hospital, Lon- 
don, Eng, September 1963. 

4. Kill, F. : Development of a parallel-flow artificial kidney in 
plastics. Acta Chir Scand Suppl 253; 142, I960. 

5. Freeman, R.B., Setter, J.G.; Maher, J.F. and Schreiner. G.E.: 

Characteristics and comparative efficiencies of cold and parailel- 
flow he mo dialyzers. Trans Am Soc Artif Int Organs 10: 174, 

6. Scribner, B,H., Caner, J.E.Z., Buri, R. and Quinton, W.: The 
technique of continuous flow hemodialysis. Trans Am Soc Artif 
Int Organs 6: 88, 1960. 

7. Pendras, J.P., Cole, J.J., Tu, W.H. and Scribner, B.H.: Im- 
proved technique of continuous flow hemodialysis, trans Am Soc 
Artif Int Organs 7: 27, 1961. 

8. Quinton, W.E., DlHard, D.H., Cole, J.J. and Scribner, B.H. : 
Eight months experience with silastic-teflon bypass cannulas. 
Trans Am Soc Artif Int Organs 8: 236, 1962. 

9. Teschan, P.E., Baxter, C.R., O'Brien, T.F., Freyhof, J.N. and 
Hall, W.H.: Prophylacfic hemodialysis in the treatment of 
acute renal failure, Ann Int Med 53: 992, 1960. 

10. Parsons, F.M., Hobson, S., Blagg, C.R. and McCracken, B.H.: 
Optimum time for dialysis in acute reversible renal failure, The 
Lancet 1: 129, 1961. 

lOA. Personal Communication. 

11. Alwal!, N.: Therapeutic and Diagnostic Problems in Severe 
Renal Failure, Scandinavian University Books, Svenska Bokfor- 
laget, Stockholm, Sweden, Chap 16. 

HA. Personal communication with Dr. N. Alwall. ^^ 

12. Easterling, R.E. and Forland, M. : A five year experience with f 
prophylacfic dialysis for acute renal failure, Trans Amer Soc 
Arfif Int Organs 10: 200, 1964. 

12A. Personal communications wih Dr. Easterling. 

13. Personal communicafion. 


Current Blood Banking Operations 

LCDR R. W. Foley'' MC JJSN. From the Proceedings of the Monthly Staff Conferences 
of the V. S. Naval Hospital, NNMC, Bethesda, Maryland 1963-1964. 

We would like to present a brief status report on the 
activities of the Blood Bank— a report to our consum- 
ers. First, we would like to answer the question: 
"Where is the blood obtained?" The first slide shows 
that we had a total of 5,945 donors in 1963; of these, 
5,454 were accepted and drawn. The remaining 491 
were rejected for a wide variety of reasons, including 
history of jaundice, elevated temperature or hemoglobin 
level below 12.5 Gm%. Approximately 75 percent of 
our donors are military, while the remainder are 
civilians, usually military dependents or government 
employees. The civilian group tends to have a higher 
number of repeat donors as they are permanent resi- 
dents of the area. Many of these people are members 
of the Gallon Club, having donated more than eight 

Three-quarters of all the blood is obtained on 
"mobile donor runs." A team consisting of a medical 
officer, a nurse, and five corpsmen travels to these out- 
lying activities twice a week. It is quite apparent that 
donor procurement relies heavily on the zeal of the 
local representatives attached to the contributing com- 
mands. The donor program is aided by the fact that 
credits are given to donors for their contributions which 
can be redeemed when they or their dependents require 
blood. This is a valuable inducement among civilian 

The Donor Center prefers to keep National Naval 
Medical Center personnel available as walking donors, 
an immediately accessible pool of fresh blood. The 
demands placed on these standby donors are more in- 
convenient to the individual than the regular donor. 
The cooperation of the Wards and Departments of the 
Center is required to support the enormous blood needs 
of cardiac surgery. 

The Blood Bank obtains units from the American 
Red Cross when the less common blood groups are in 

At the time of this presentation, Dr. Poley was a Senior Resident 
in Pathology at the U.S. Naval Medical School, NNMC, Bethesda, 
Md. He is now stationed at the U.S. Naval Hospital, Jacksonville, 
Fia., where he serves as a Staff Member of the Palhology Service. 

short supply. A total of 1,023 units were provided by 
the American Red Cross last year. 

The second question we would like to answer is: 
"How is the blood used?" The following chart depicts 
how the blood is utilized: 


Transfused at USNH, Bethesda 3,107 

Shipped to other activities 1,450 

Salvaged plasma 1,920 

TOTAL 6,477 

Of the 6,477 units received in the Blood Bank, 3,107 
are actually transfused into patients at this hospital. 
Another 1,450 are supplied to other government hos- 
pitals and the American Red Cross. Most of the blood 
needs of the Naval Hospitals at Quantico, Annapolis, 
and Patuxent River are supplied by this Blood Bank. 
Waher Reed Army Hospital, the Clinical Center of the 
National Institutes of Health, and the American Red 
Cross act as a clearing house for the emergency require- 
ments of civilian institutions in the area. Blood that 
exceeds the 21 -day shelf-life at 4° Centigrade is 
salvaged as plasma and plasma products. In 1 963, 
1,920 units were converted to stored plasma or were 
turned over to pharmaceutical companies for credit. 
The laboratory received products worth $ 1 ,872 in 

Less than half of the units cross-matched are trans- 
fused into patients at this hospital. About 63 percent 
of all cross-matched units are released after 72 hours. 
Many units are cross- matched several times during 
their 21 -day life. More frequent use of the "group- 
type and hold" procedure as backup to multiple unit 
transfusions would reduce the number of cross-matches 
and conserve expensive sera. 

In addition to the usual ACD whole blood, packed 
red cells, frozen plasma, stored plasma, and pediatric 
units are provided on request. Fresh whole blood 
can be obtained from local donors for the treatment 


of thrombocytopenia within 2 to 3 hours. The yield 
of platelets per unit is far greater when given as whole 
blood in contrast to concentrates. To be effective, 
platelet concentrates must be prepared from many units 
of fresh whole blood. 

The third question we would like to answer is : 
"What are the complications encountered by the trans- 
fusion service?" During 1963, about 2 percent of all 
transfusions resulted in detectable clinical reactions. 
Only one reaction was definitely proved to be hemoly- 
tic. Fortunately, this antigen-antibody incompatibility 
resulted in minimal red cell destruction and produced 
a slight transient symptom that almost went unnoticed. 
The last fatal transfusion reaction at U.S. Naval Hos- 
pital, Bethesda, Md., occurred many years ago. It is 
possible that this death was the result of bacterial con- 
tamination of the unit. The insidious, cold-growing, 
gram-negative organism produced no visible change in 
the supernatant plasma; the unit was given to the 
patient who expired in a matter of hours. 

The possibility of hemolytic transfusion reaction 
lurks in every transfusion ordered. Although Ward 
and Blood Bank personnel may become impatient with 
the seemingly rigid procedures, these are the patient's 
greatest safeguard. The system has built into it "fail- 
safe" mechanisms just as the Polaris missile has. 

The titration laboratory plays an essential role in 
preventing dangerous hemolytic reactions. Patients 
scheduled to receive multiple transfusions are ex- 
haustively studied in order to detect potential sensitiz- 
ing antigens. Troublesome units can then be eliminated. 

The great bulk of the work (about 70 percent) 
however, deals with the routine screening of obstetrical 
patients. All mothers are Rh-typed and screened for 
the presence of immune antibodies which could cause 
fetal erythroblastosis. Patients who are found to be 
Rh-negative are worked up further and periodic anti- 
body titers are obtained during pregnancy. 

Although most transfusion reactions are allergic 
or pyrogenic in nature, ward personnel should care- 
fully observe patients being transfused. This is particu- 
larly important during the administration of the first 
100 cc, since potentially fatal massive hemolysis can be 
prevented by discontinuing the transfusion at the first 
adverse sign. It is advisable to order the recording of 
vital signs during this crucial interval. This will assure 
that the patient is closely watched. 

When a transfusion is discontinued due to a reaction, 
the Blood Bank officer or the OOD of the Naval Medi- 
cal School should be notified immediately. Blood Bank 
personnel will then evaluate the patient in order to 
determine the following: 

1. What caused the reaction, and 

2. If the reaction was hemolytic, how severe was 
it and what antigen-antibody system was re- 

The following chart outlines our workup of a trans- . 
fusion reaction: ^^ 


1. History and Physical examination 

2. Urine for free hemoglobin 

3. Plasma for free hemoglobin 

4. Serum for haptoglobin, methemalbumin, and bili- 

5. Blood for titration laboratory 

a. Direct Coombs 

b. Other immunohematology studies to determine 

the source of reaction. 

6. The discontinued unit of blood 

a. Tests for compatibility 

b. Culture 

c. Supernatant hemoglobin 

7. Follow-up studies 

a. Urinary output 

b. Others as indicated 

The other significant complications of transfusion 
is serum hepatitis. The carrier rate among donors has 
been given as 1 in 200, while the incidence of hepa- 
titis has been reported as ranging from 1 to 7 percent. 
The incidence varies considerably with the type of 
donor population available and with the average num- ( 
her of units given each patient. Professional donors 
and open-heart-pump patients tend to push this figure 

When we investigated all recorded cases of serum 
hepatitis at this hospital in the last five years we found 
a total of nine. Two of these were infected during an 
influenza immunization program on a ship. Of the 
remaining seven, three resulted from single unit trans- 
fusions. These included a 71 year-old female who re- 
ceived one unit during a hip pinning operation, an 18. 
year-old male who received one unit during the resec- 
tion of a parotid tumor, and an 18 year-old female who 
received one unit for blood loss due to a spontaneous 
abortion. Only the first of these cases resulted from 
blood given at this hospital. 

The multiple transfusion cases of serum hepatitis 
consist of two patients with severe burns (one received 
8 units, the other 4 units), an open-heart surgery 
patient (12 units), and an auto accident victim with 
a compound fracture of the angle (4 units). Three of 
the four received their blood at this hospital. There 
were no fatalities. So we have been able to find four 
cases of serum hepatitis that resulted from blood given 
at this hospital during the last five years. Additional 
cases attributable to our Blood Bank may have been 
treated at other medical facilities, however. This num- 
ber is probably not high, since the entire Navy re- f* 
ported only 12 cases of serum hepatitis in 1962 and 8 
cases in 1961. It is possible that these Bureau of 


Medicine and Surgery figures may not represent the 
entire picture. Additional cases may be lost among 
600 cases of infectious hepatitis from all causes re- 
ported annually. 

In summary, the Donor Center of the U.S. Naval 
Medical School, NNMC, has been able to meet its 

increasing commitments for blood by going to the 
donor. The special needs for walking donors and fresh 
blood are met by the National Naval Medical Center 
base personnel. The incidence of hemolytic reactions 
and serum hepatitis is surprisingly low. The latter can 
be attributed to well-motivated volunteer donors. 





duty. Further information concerning how you can 
volunteer can be obtained by contacting BuMed, Attn: 
Code 31. — Medical Corps Branch, Professional Div., 

The U.S. Navy has the annual task of supporting a 
long-range scientific operation in Antarctica which is 
under the auspices of the National Science Foundation. 
Plans are now being formulated for next year's opera- 
tion which will be known as the U.S. Antarctic Re- 
search Expedition. 

During the operation, the Navy will support five 
bases in Antarctica (Pole, Byrd, McMurdo Sound, Cape 
Hallett, and Eights Station) with a medical officer at 
each of the first four bases (Flight Surgeon at McMur- 
do Air Facility). Personnel at these bases will vary 
from 15 to 100 men, including 3 to 15 civilian scientists 
who will investigate not only earth sciences, such as 
weather, geology, seismology, and glaciology, but also 
the biological and medical sciences. Antarctic doctors 
are invited and encouraged during their tour of duty 
to study the medical problems of isolation, acclimatiza- 
tion, and cold weather physiology. 

Special training for medical officers will begin in the 
spring or early summer of 1965 in orthopedics, general 
surgery, anesthesiology, EENT, psychiatry, emergency 
dental care, cold weather medicine, hygiene and sani- 
tation, and survival in the polar regions. 

In the fall of 1965, after training has been com- 
pleted, the party will embark for Christchurch, New 
Zealand and then to Antarctica. Individuals will re- 
main at their respective bases in Antarctica until No- 
vember or December 1966 when they will return to the 
Continental United States for reassignment, usually to 
a duty station of their choice from among available 
billets. Assignment to this operation is available to 
qualified medical officers on active duty or inactive 




Class Number 
Class #17 

Inclusive Dates 
I March— 23 April 1965 

Commencing with the above class the schedule of the 
Radioisotope Techniques and Nuclear Medicine Course 
for Medical Officers has been changed to convene in 
March and September, The course is conducted at the 
U.S. Naval Medical School, National Naval Medical 
Center, Bethesda, Md. In view of the limited quota 
and shortage of travel funds for attendance at short 
courses, only those Medical Officers who require the 
course as an integral part of their residency training 'or 
as an important factor in the performance of their cur- 
rent assignment can be authorized to attend. Travel 
and per diem funds will be provided in accordance with 
budgetary limitations. Officers who cannot be provided 
with travel orders to attend at Navy expense may be 
issued Authorization Orders by their Commanding Offi- 
cers following confirmation by this Bureau that space 
is available in each case. 

Requests should be forwarded in accordance with 
BUMED INST. 1520.8A at least six weeks prior to 
commencement of the requested course. 

The exact inclusive dates of Class #18, convening 
in September 1965 will be published at a later date. 
^Training Branch, Professional Div., BUMED. 



BuMed Instruction 1520.12B requires that ALL 
MSC officers (2300, 2302, 2305) who desire to be con- 
sidered for assignment to duty under instruction at the 
Naval School of Hospital Administration, Bethesda, 
Md., must submit individual letter requests. Requests 
should contain a complete resume of academic back- 
ground, including transcripts of courses completed, un- 
less they have been previously furnished the Bureau, 
plus other requirements of the above instruction. Re- 
quests for the NSHA class convening in August 1965 
must reach the Bureau prior to 1 January 1965. 


The primary mission of the Medical Service Corps is 
to support all phases of Medical Department operations. 
In order to render the best possible support, each offi- 
cer must exert strong influence upon himself to improve 
his performance of duty and professional competence. 
Throughout his career the officer must continue to 
study and grow intellectually if his performance is to 
improve commensurate with increasing responsibilities 
resulting from promotion to higher grade. 

In 1942 the need for developing officers in the field 
of hospital and medical department administration was 
recognized. Therefore, a Training Department was es- 
tablished at the U.S. Naval Hospital, National Naval 
Medical Center, Bethesda, Md., to meet this urgent 
need. In 1943 the Training Department was redesig- 
nated as the Hospital Corps Officers School, and in 
1 945 the present Naval School of Hospital Administra- 
tion was established. 

From 1942 to 1960 approximately 800 Hospital 
Corps and Medical Service Corps officers completed 
the course of instruction without receiving any aca- 
demic credit for their achievement: However, the 
knowledge gained from that school has guided those 
officers in performing the most difficult administrative 
assignments within the Medical Service Corps. 

On 5 August I960, the Bureau of Medicine and 
Surgery authorized a cooperative, program with the 
George Washington University,, Washington, D.C., pro- 
viding for the establishment of an off-campus center of 
the College of General Studies at the U.S. Naval School 
of Hospital Administration. Since that time, 142 Navy 
MSC officers have graduated from the 10 months 
course. Forty-three of this group have completed their 
baccalaureate degree and of this group, seven have also 
finished their Master's program. Seventy-four of the 
remaining ninety-nine officers are actively pursuing 
their degree by participating in part-time, off-duty 
courses of instruction. Thirty-five are working in their 
senior years while thirty-nine are participating on the 
junior level. These officers are to be commended for 
their foresightedness and dedication to this educational 

endeavor which requires so much time and effort in \^ 
addition to their regular duties. 

It is encouraging to note the large percentage of 
MSC officers who are taking advantage of the credits 
earned at the Naval School of Hospital Administration 
by continuing their degree program. It is realized that 
there are many factors to be considered in participating 
in off'-duty courses of instruction. However, eflforts ex- 
pended will undoubtedly pay great dividends in the fu- 
ture career development of the officers concerned. It 
is significant to note that all but 18% of the NSHA 
graduates since 1961 have found time to continue their 
academic program. 

There are 152 MSC officers pursuing their education 
under BuMed sponsorship during the Fall Semester 
1964. It is estimated that in addition to this number, 
approximately thirty officers are pursuing a degree pro- 
gram by other means. 

The attention of all Medical Department officers is 
invited to the provisions of BuMed Instruction 1500.7A 
in regard to the financial assistance offered by BuMed 
in support of part-time, outservice training, and all offi- 
cers are encouraged to continue their education which 
is so necessary to meet the challenges of changing con- 
cepts in all fields of professional endeavor. From: 
CAPT R. S. Herrmann MSC USN, Director, Medical 
Service Corps Division, BUMED. 



Selection of Camera Filters for Color Photography, 
by C. S. McCamy, National Bureau of Standards Mis- 
cellaneous Publication 259; June 26, 1964; chart; 5 
cents. (Order from the Superintendent of Documents, 
U.S. Government Printing Office, Washington, D.C. 
20402, or from local U.S. Department of Commerce 
Field Offices.) 

One of the most difficult problems facing a serious 
color photographer^ — whether he is a hobbyist or a 
scientist — is matching his color film to the light he is 
using to take the picture. 

Color films are usually balanced for a particular kind 
of light classified as ''daylight," "fiash," "3200°K," or 
"photoflood." When a film is used in fight of a differ- 
ent color, filters are used over the camera lens to bring 
the combination back into agreement. This chart pro- 
vides a quick and easy method of selecting the light 
filter for almost any combination of light source and 
color film. To select the correct filter, the photographer 
simply lays a straightedge across the three scales so 
that it connects the points corresponding to the light 
source and the color film. The straightedge will then 
cross the center line at a point corresponding to the 
proper filter. NOTE: Foreign remittances must be in 
U.S. exchange and should include an additional one- /^ " 
fourth of the publication price to cover mailing costs. 
— From: U.S. Department of Commerce, National 
Bureau of Standards, October 1964. 




Dr. Norman H. Olsen, Northwestern University School of Denistry. Practical Dental 
Monographs, September 1964, pages 24-27. Year Book Medical Publishers, Inc., Chi- 
cago, 111. 


A conservative method of restoring fractured young 
permanent incisors employs the use of wire pins in con- 
junction with a rapid setting resin. The wire pin is 
utilized to retain the self-curing resin. "It has been ob- 
served that most of the fractures of the Type III variety 
(coronal fracture with a considerable amount of dentin 
exposed, but no pulpal involvement) may be divided 
into two classifications. The first is a fracture involving 
only one angle — either the mesial or distal angle. The 
second is a horizontal type of fracture involving both 

the mesial and distal angles of the tooth. The only 
preparation of the tooth in addition to placement of a 
wire for retention is removing any bevels resulting from 
the fracture. Retention holes for 23-gauge nichrome 
wire are made with a tapered 699 fissure bur. In the 
horizontal type of fracture, the retention holes are 
placed just inside the dento-enamel junction. The depth 
of these holes should be such that as much wire extends 
out of the tooth as extends within the tooth. (Fig. I) 
In restoring an angle, the wire that extends along the 


Fig. 1. — Mode of restoring both the angular and horizontal type of fracture with rapid-cure resin material using 
a wire pin for retention. 


long axis of the tooth may extend as far into the tooth 
as it extends out of the tooth. However, the other 
end of the wire must be placed only to such a depth 
as to make the wire retentive. The 23-gauge nichrome 
wire is bent so that it has to be sprung into place and 
is retentive prior to its cementation. The wire is then 
cemented with zinc phosphate cement (not with resin 
material). The fractured portion can then be restored, 
utilizing the brush technic or using a resin form that 
has been adapted to the tooth. This mode of treatment 
provides an excellent esthetic result with a minimum 
amount of preparation of the tooth. The shortcoming 
of this treatment is that the color of the resin has to 
be modified from time to time. 

dental and medical students. In its first few months i _y 
of operation, the educational assistance program is 
proving to be of great benefit to a number of dental 
schools which had not been able to raise sufficient 
funds to replace their obsolete and inadequate teaching 

Military Pay and Draft Law — Congress extended un- 
til 1967, the so-called "doctor draft law" which author- 
izes the drafting of dentists and physicians into the 
military services. In addition to increasing military pay 
rates generally. Congress also raised the special pay for 
dentists and physicians who remain in military service 
over six years. 

Military Retirees and Dependents — Congress studied 
and received testimony on dental care for military re- 
tirees and their dependents, but no action was taken. 


Bulletin of the Council on Legislation, American Dental 
Association, No. 88-20, September-October 1964. 

The 88th Congress, which adjourned on October 3, 
after being in session almost continually for 21 months, 
considered many matters of interest to the health pro- 

The preeminent issue was, of course, the controver- 
sial legislation to include health care benefits under the 
social security system. In the waning days of the re- 
cently concluded Congress, a stalemate between House 
and Senate Conferees resulted in the shelving of a so- 
called "medicare" program along with cash benefit in- 
creases for social security pensioners. 

Health Professions Educational Assistance Act — The 
first session of the 88th Congress also enacted a grant 
program to assist dental and medical education. Under 
this program, six dental schools already have received 
approval of grant applications totaling nearly $17 mil- 
lion in fiscal 1965. Several of the schools will replace 
completely their teaching facilities while others will 
renovate and expand their existing facilities. To date, 
no applications for new dental schools have been ap- 
proved, although reportedly, new schools are contem- 
plated in Connecticut, Florida and South Carolina. 
Under the program, the federal government will con- 
tribute from 50 per cent to 66% per cent of construc- 
tion costs. Thirty-seven schools have indicated an 
intent to apply for funds under the construction phase 
of the program. The law also authorizes grants to 
schools to establish low-interest loan funds for needy 


Washington Report on the Medical Sciences,'"' No. 903, fJ 
October 12, 1964. Published by WRMS, 1308-19th 
Street, N. W., Washington 6, D. C. 

A ruling by Internal Revenue Service should have 
the effect of accelerating an already brisk business- 
leasing of special devices for fluoridating individual 
home water supplies. The IRS decision: That the in- 
stallation and rental costs of such devices are deducti- 
ble as medical expenses if they rise out of professional 
dental service. 

This takes care of the tax angle but yet to be de- 
cided, by Food and Drug Administration, is question 
whether manufacturers of the appliances — and there 
are several of them — must get pre-clearance certifica- 
tion of effectiveness. Another question; Is the food 
additive law to be invoked here? 

At least one of the manufacturers has queried FDA 
on these and related points but so far neither he nor 
any other has applied for a "new drug" permit. The 
devices are being marketed and sales are reportedly 
good in rural and some suburban areas of the country 
where wells are the water source. The Public Health 
Service, which for years has studied practicability of 
individual fluoridation, is nearing completion of an in- ^^ 
vestigation in suburban Montgomery County, Mary- f 
land, covering about 150 families whose well water is 
being fluoridated. *{Editor: Mr. Gerald G. Gross) 




Dental Students' Magazine 43(1): 36-42, October 1964. 
Student's Magazines, Inc., Winnetka, Illinois. 

Established by an Act of Congress in June 1948, the 
National Institute of Dental Research started investi- 
gations into the causes, prevention and treatment of 
diseases of the mouth. Its early studies were continu- 
ations of the research that led to the fluoridation of 
communal water supplies. 

A research grants program, started tvv'o years later, 
has now grown to the extent that ten million dallars is 
expended annually in support of 400 research projects 
in 129 universities and research institutions, including 
all the dental schools of this country. Currently an 
annual expenditure of six million dollars is devoted to 
fellowship and training programs. The latter supports 
about 80 separate training programs in 55 institutions 
providing training opportunities for some 375 potential 
scientists. This is an effort to curtail the existing short- 
age of available dental research capability, particularly 
in support of dental education. Included in the pro- 
gram are also approximately 100 fellows and 40 re- 
cipients of Research Career Development Awards. 

At the Institute itself, a vigorous program encom- 
passing a broad spectrum of dental research is carried 
on by a highly skilled staff. An annual budget now of 
approximately three and one-half million dollars gives 
some insight as to the scope of the research conducted 
at the Institute. Since its inception, the National Insti- 
tute of Dental Research has devoted its efforts to the 
study of oral diseases that are destructive, painful. 
incapacitating and expensive to the American people. 


Dr. Ralph Tompsett, Chief of Internal Medicine, Bay- 
lor University, Dallas, Texas. Disease-a-Month, Sep- 
tember 1964. Published by the Yearbook Medical 

Service. Chicago. Illinois. 

Bacterial endocarditis is a disease which has been 
of special interest to clinicians for many years. Its 
multiplicity of symptoms and signs has intrigued teacher 
and pupil alike. Many isolated case reports have been 
published as examples of infection either rarely or 
never seen in other sites in man. It provides one of 
the most striking examples of the benefits obtained from 

modern antimicrobial therapy. It is, however, a rela- 
tively rare disease which the average physician sees so 
uncommonly that it is difficult to gain proper perspec- 
tive about it. A thoughtful and authoritative review 
of bacterial endocarditis was prepared by Hunter and 
Paterson in 1956. Since that time, considerable ex- 
perience has been gained in the management of this 
disease so that we now are better prepared to assess 
the results of conventional therapy. Several new drugs 
have been discovered which materially alter the out- 
come in some patients. The advances in surgery of 
the heart have solved some problems and at the same 
time provided some new ones. For these reasons, it 
seems appropriate at this time to review the current 
status of this disease. Doctor Tompsett presents, in 
the complete article, a thorough picture of the clinical 
features, causative microorganisms, diagnosis and treat- 
ment of bacterial endocarditis. No attempt is being 
made in this abstract to cover the more medical as- 
pects, however, the dentist's responsibility is well spelled 
out in the section on prophylaxis. 

Prophylaxis. In view of the fact that endocarditis is 
a complication of bacteremia in patients with cardiac 
lesions, it has seemed reasonable from the outset to 
attempt to protect such patients who are a risk by pro- 
phylactic administration of antimicrobial drugs. Prob- 
ably the most common type of bacteremia, and certainly 
the most readily studied, has been that occurring after 
tooth extraction. This has been shown to be preventable 
with penicillin, tetracycline or chloramphenicol. Other 
situations known to be followed sometimes by endo- 
carditis are less readily studied but include manipula- 
tion of abscesses, cystoscopy, normal delivery and 
therapeutic abortion. Proof is really lacking that the 
customary practices of prophylaxis are of value. Most 
authorities, however, recommend administration of 
penicillin at the time of tooth extraction starting a few 
hours before extraction in routine cases, or two to 
three days before (if possible) in the presence of apical 
abscesses. Tetracycline seems equally acceptable if 
there is any suggestion of hypersensitivity to penicillin. 
Proper prophylaxis in the other situations is even less 
certain. The author's practice is to give tetracycline, 
1.0 gm daily, as prophylaxis except where staphylococci 
may be involved. In patients with heart disease who 
have localized staphylococcal infection requiring sur- 
gery, it seems reasonable to administer some anti- 
staphylococcal drug such as erythromycin, novobiocin 
or oxacillin if one is not already being given. Whether 
or not prophylaxis is of value in the patient who has 
cardiac surgery cannot be answered at this time. The 
fragmentary evidence available suggests that pro- 
phylaxis has been of little value in the surgical patient. 



CAPT Angus W. Grant DC USN. Executive Officer, 
V. S. Naval Dental Clinic, Long Beach California.'^ 

Background , The Defense Medical Supply Center is 
in receipt of numerous deficiency reports from Naval 
dental activities regarding the quality of ASA Speed 
Group Film (FSN 6525-663-1558), The employment 
of this ultra-speed type film is essential in the extended 
cone intra-oral roentgenographic technique advocated 
by the Dental Division of the Bureau of Medicine and 
Surgery {U. S. Navy Medical News Letter, 44(3), 7 
August ]964). A great number of these deficiency re- 
ports is based on dissatisfaction with the density and 
contrast of the processed roentgenogram. It is felt that 
this is not the fault of the film itself but perhaps a lack 
of proper darkroom technique with resulting discrep- 
ancies in processing this type of sensitive film. 

Discussion. In consonance with the augmented radi- 
ation requirements of the increased focal-film distance 
in the extended cone technique, the ultra-speed film is 
necessarily employed to reduce exposure time (MAS) 
and, consequently, to minimize patient radiation. A 
thorough knowledge of the inherent characteristics of 
this particular speed group film is imperative if opti- 
mum results of its use are to be obtained. 

Film Speed — ^Film speed is governed by several fac- 
tors, one of which is the size of the silver halide crys- 
tals in the emulsion— the larger the crystals, the faster 
the film speed. At the same time, the faster films are 
more sensitive to radiation, extraneous light, and film 
fogging. It is therefore most important that special 
care be taken in handling this group film. 

Film Fogging — One of the most common causes of 
poor film quality exhibited in fast films is over-all fog- 
ging. To be considered here are the following causes: 

1. Improper stowage of film 

2. Unsafe darkroom illumination 

3. Improper darkroom procedures 

Film Stowage — Scattered and secondary radiation 
(which are inherent in any roentgenographic proce- 
dure) are concomitantly increased by higher kilovolt- 
ages. Unstowed films, or those in other than lead-lined 
receptacles, many become fogged by this type of radia- 
tion if located in the near vicinity of the operating x- 
ray unit. The faster speed films are decidedly more 
susceptible to this hazard than the slower types. 

Film emulsions are extremely sensitive to relative 
humidity ranges above 60 and air temperatures above 
90. To prevent fogging from these sources, special care 
must be taken in storing dental films under these ad- 
verse conditions. The use of air-tight containers and/ 
or stowage in a cool area (refrigerator, etc.) is recom- 

* Captain Grant was Head of the Oral Diagnosis Department at 
the U.S. Naval Dental School, NNMC, Belhesda, Md,, before his 
current assignment. 

mended. Refrigerated film must be returned to room 
temperature prior to exposure to roentgen rays. 

Darkroom Illumination — Items to be thoroughly cor- 
rected in processing procedures of fast film are: ex- 
traneous light leaks, safelights of too high a wattage 
and improper or cracked filters. These items, of course, 
apply to all speed films; however, the extreme sensi- 
tivity of the larger grained halide crystals in the emul- 
sion of the "ultra-speed" or "lightning fast" films are 
very susceptible to even minor amounts of extraneous 
or excess light. "Light fog" with accompanying in- 
creased film density and impaired contrast will result. 
The word "safelight" is actually a misnomer since 
film fogging will result on any emulsion which is sub- 
jected to subdued light for an excessive length of time. 
The maximum time that unwrapped film should be ex- 
posed to a safelight under any conditions is five minutes. 
Therefore, unwrapping such quantity of films that 
would require more than five minutes should be 

The recommended minimum distance from lamp to 
work area is four feet and this requirement should be 
respected even if space limitations preclude it. In those 
confined areas (shipboard, etc.) wherein the four foot 
limitation is an impossibility, the safelight bulb should 
not exceed two watts per-foot-distance from light to 
work area. Ideally, under this condition, no safelight 
is employed. 

Light filters should be checked for cracks and light 
leaks, both of which would render them useless. A 
simple procedure for checking the "safety" of the safe- 
light and filter is to lay an unwrapped film on the work- 
ing area of the darkroom table directly under the safe- 
light. Place a small metal object, such as a coin or 
paper clip, on top of the film and allow it to remain for 
approximately one minute. If, after normal developing 
and fixing procedures are performed, an image of the 
metal object is discernible on the film, the safelight is 
not safe. 

Processing Solutions— The importance of maintain- 
ing proper care and optimum temperature of the 
developing and fixing solutions cannot be over -em- 
phasized. Quality results of excellent exposure tech- 
niques can be, and are, completely nullified by im- 
proper procedures in the darkroom. The optimum 
temperature of the processing solutions as recommended 
by the individual manufacturers is 65 or 68 degrees 
Fahrenheit depending upon the brand. Special care 
should be taken to abide by their recommendations. 
Higher temperatures not only hasten development but 
also produce chemical fogging which obscures the 
image on the film. Lower temperatures retard develop- 
ment and tend to decrease the density of the image de- 
spite the fact that prolonged development may be 
employed. Additionally, hydroquinone (one of the 
chemicals of the developer which controls contrast) is 
very sensitive to temperature changes — below 60 de- 
grees it becomes inactive. In certain localities, tap 



water contains minerals and is therefore termed "hard 
water." If used in preparing processing solutions, a 
precipitate may form. Water that has been heavily 
chlorinated may also contaminate solutions and destroy 
their effectiveness. In these instances, it is advisable 
to use distilled water, since it is free from foreign 

Conclusion. The employment of the fastest speed 
dental films available is a necessity in extended cone 
intra-oral roentgenography to keep exposure time _to an 
acceptable minimum range. However, dissatisfaction 
with the resulting roentgenograms will be evident if 
proper management of their inherent sensitivities is 
not exercised. Compliance with manufacturers' recom- 
mendations and accepted darkroom disciplines will pro- 
vide the dental practitioner roentgenograms of the 
highest quality. 


Admiral Kyes Presents Navy Dental Program at Meet- 
ing of Military Surgeons. Rear Admiral F. M. Kyes, 
Assistant Chief of the Bureau of Medicine and Surgery 
(Dentistry) and Chief of the Dental Division presented 
a three-step dental treatment program for the U.S. Navy 
at the 71st Annual Convention of the Association of 
Military Surgeons, held 20-22 October 1964, in Wash- 
ington, D. C. 

The first two steps, preferential treatment of early 
lesions and the cement alloy program have been in 
operation for several years. The third step, to conduct 
research, development, test and evaluation necessary for 
an effective system of annual application of stannous 
fluoride agents is an ambitious proposal that can be 
applied throughout the Armed Forces. Admiral Kyes 
outlined dental research programs at the U.S. Naval 
Submarine Medical Center New London, Groton, Con- 
necticut; U.S. Naval Dental Clinic, Norfolk, Virginia; 
and the Dental Research Facility of the U.S. Naval 
Training Center, Great Lakes, Illinois. 

Based on encouraging stannous fluoride cariostasis 
results at New London, a clinical study at Norfolk 
found properly instructed groups of men, using a stan- 
nous fluoride/ lava pumice mixture on their own tooth- 
brushes, were able to clean enamel surfaces essentially 
as well as the technician with a rotary rubber cup. 
This has inspired two parallel programs at selected 
naval activities, one directing self-application in men 
under 25 years of age (those with less calculus), and 
those older men who require more than simple polish- 
ing of exposed surfaces. These tests are designated to 
provide a valid basis for a three agent stannous fluoride 
program which can be applied annually to all naval 
personnel by the fall of 1965. 

New Dental Facilities Opened at Great Lakes. Rear 
Admiral H. A. Yeager, Commandant, NINTH Naval 
District announced the opening of a new medical/ dental 
facility at the U.S. Naval Training Center, Great Lakes, 
Illinois on 2 October 1964. The Dental and Medical 
Departments of the Administrative Command will share 
occupancy of the $1,800,000 building which replaces 
temporary facilities in use since World War II. 

Rear Admiral F. M. Kyes, DC USN, Assistant Chief 
of the Bureau of Medicine and Surgery (Dentistry) 
officiated at ceremonies opening the dental facility. He 
was assisted by CAPT G. L. Parke DC USN, Director, 
Dental Activities, NINTH Naval District, and CAPT 
M. G. Turner DC USN, Dental Officer, Administrative 
Command, U.S, Naval Training Center, Great Lakes, 

The modern air-conditioned dental spaces, occupying 
two stories of the South wing of the building, are 
equipped with new units and chairs, mobile dental cabi- 
nets, operating stools, diffuse overhead lighting and a 
central oral evacuation system. The fifty chair clinic 
includes thirty-five rooms for operative dentistry, four 
each for prosthetics, oral surgery and periodontics, and 
three for endodontics. In addition there are two roent- 
genographic units, a phosthetic laboratory which accom- 
modates eighteen technicians, a central sterflizing room, 
a recovery room for surgical cases and administrative 
offices. A sixteen bed ward is available for dental 

An "open house" was held on 3 October 1964 featur- 
ing refreshments and a guided tour of the new facilities. 
Invited guests included members of the Navy Dental 
Corps and their families. Dental Officers from neigh- 
boring Arsned Forces, and members of the Veterans 

Participation in Professional Meetings. CAPT A. R. 
Frechette DC USN, Commanding Oflicer, U.S. Naval 
Dental School, National Naval Medical Center, Bethes- 
da, Maryland, presented a lecture, "Partial Dentures," 
for the First District Dental Society, New York, New 
York. CAPT Frechette also participated in the Annual 
Session of the American Dental Association by present- 
ing an essay, "Complete Denture Stability," and by 
moderating a panel discussion, "Immediate Dentures." 

CAPT Gordon H. Rovelstad DC USN, presented a 
lecture, "Dentists' Responsibility to Preventive Dentis- 
try," for the Alpha Omega Fraternity, in Washington, 
D.C., on 4 November 1964. He will also present an 
essay, "Salivary Components and Their Relationship 
to Oral Disease," at the American Association for the 
Advancement of Science, in Montreal, Canada, on 27 
December 1964. 

CAPT P. C. Alexander DC USN, presented a clinical 
lecture, "The Periodontium and the Cuspid Protected 
Occlusion," at the Annual Session of the American 



Dental Association, in San Francisco, California. 

CAPT Joseph "L" Tenaglia DC USN, presented a 
lecture, "The Mandibular Third Molar; its Manage- 

ment," at the Scientific Session of the Zambales Dental 
Society Meeting in the Republic of the Philippines, on 
4 October 1964. 



HMC Charles W . Roane USN. Sanitation Section, Health Practices Branch. Preventive 
Medicine Division. BUMED. 

(Editorial Note: Chief Roane is one of several personnel from U.S. Navy Preventive Medicine Unit Number 6, 
Pearl Harbor, Hawaii, who conducted pest control training on Guam when typhoon "Karen" struck in Novem- 
ber 1962. This article is the result of the experiences of these personnel following the disaster. While this report 
deals with the outgrowth of a disaster on a tropical island, the principles of organization, logistics control, and 
operational pt^cedures have general applicability to all shore activities.) 

1. Introduction. Voluminous plans and reports exist 
for disaster control at most naval shore activities. Be- 
cause of their bulk, they may sometimes be briefly 
scanned during a person's first days on a new job and 
seldom reviewed thereafter. This report is intended as 
a brief, workable plan which may be put into operation 
within a minimum of time and convenient for ready 

2. Establishment of a Sanitation Command Post. 

a. The Preventive Medicine team has the responsi- 
bility of establishing a sanitation command post in a 
suitable place such as pest control or sanitation head- 
quarters. The command post should have at least two 
telephone lines if possible. 

b. Make contact with all sanitation personnel in the 
area who may be of assistance, including military sani- 
tation personnel, local public health authorities, and 
local civilian sanitarians. They should be advised to 
channel information and requests for information and 
assistance through the command post. They should in- 
form the command post of their whereabouts during 
the emergency. 

c. Convene a meeting of these personnel as soon as 
possible and explain the current situation. Publish or 

otherwise designate the sanitation tasks for each per- 
son. Task areas must include water sampling, food 
service area sanitation, garbage collection, and control 
of insect breeding areas. 

d. Make these people your eyes and ears. Have them 
report at least once daily. You must designate respon- 
sibility for collection of information, for you will not 
have time to do it yourself. 

e. Maintain liaison with key personnel in other mili- 
tary departments: all commanding officers, the public 
works oflicer and his master mechanics and foremen, 
the transportation officer, the supply officer or his 
delegated representative for your interests, and the 
person in charge of the water plant. Many reports will 
funnel in to these people about conditions that will 
appear to untrained eyes as far worse than those 
actually existing at this time. You may save them many 
headaches if they will allow you to investigate the 
reports and abide by your recommendations for action 
on them. 

f. Make periodic reports to the medical officer who 
has been designated as Health Officer (or similar title) 
for the emergency. 

g. Investigate situations and make true reports to 
responsible authorities. 





Hot verbal exchanges are bound to occur. Tact and 
diplomacy will stand you in good stead as tempers 

i. Make effective use of the people who work for 
you. Don't push the panic button and, in spite of an 
old adage, don't ''do things just for the sake of doing 
them." Have a definite series of goals in mind and 
work steadily toward them. 

3. Water. 

a. Before the disaster strikes (advance planning): 

( 1 ) Go to the main water plant and check out 
the system with a responsible person. Continue the 
check to the periphery of the system. 

(2) Request establishment of a standing instruc- 
tion to hyperchlorinate water to 5 ppm residual chlorine 
in the event of a disaster situation (until conditions 
return to normal). 

(3) At the time of the water system survey, as- 
certain also the conditions of the sanitary and storm 
sewers and take corrective action as far as possible. 

(4) Check water reservoirs for covers. 

(5) At setting of storm condition (or disaster 
condition) :^1, direct personnel of all barracks and 
galleys to fill clean G.I, cans and other available con- 
tainers with standby water for cooking, drinking water, 
flushing heads, etc., according to previous instructions 
— and drills, if possible. Water tankers and 5-gallon 
tins of water should be taken immediately to preas- 
signed places for use as drinking water. 

b. After the disaster check on steps 3a (1) through 
(5) as test as possible. 

4. Food. 

Inspection of food sources, food service areas and 
other measures to assure safe food for consumption 
follow standard practices. It may be necessary to in- 
stitute field messing techniques with emergency field 
rations. These methods are generally well known and 
should require no amplification here. The Navy Land- 
ing Party Manual is an excellent sourcebook. 

5. Sewage and Other Wa.sle. 

a. See par. 7. 

b. Utilize existing sanitary facilities whenever pos- 
sible. When damage to the installations has occurred, 
employ field practices described in the Navy Landing 
Party Manual, Chapter 7, OPNAV P 34-03. These 
field techniques should he kept to the essential mini- 
mum, for they pose long-lasting hazards to health after 
the emergency period has passed. 

6. Pest Control. 
a. Insecticides 

( I ) Take a complete inventory of all insecticides 

available in the pest control shop, in the military sup- 
ply depot, and in civilian areas. An on-site survey of 
insecticides will be necessary. Mere checking of in- 
ventory cards is not proof of availability. 

(2) At the same time, check the supplies of 
kerosene and solvents. Avoid checking by trade name; 
check under paint solvents for mineral spirits. 

(3) Maintain the master inventory current 
throughout the operation. A blackboard and chalk are 
useful for maintaining a running inventory. 

(4) Pool only those insecticides necessary for 
fogging and spraying residuals. The rest should re- 
main in their present area until use is indicated; au- 
thorization for use should emanate only from the 
sanitation command post. 

(5) Use insecticides obtained from local civilian 
sources for local civilian treatment if possible. Tag 
these so that accountability can be maintained. 

(6) Determine what insecticides have been 
ordered but not yet received and add them to the 
master inventory. Top priority should be given to 
your requisition orders and air shipment should be 

b. Equipment 

{ I ) Prepare a master inventory of all pest con- 
trol equipment and its location in the pest control shop, 
supply depot, and in local civilian areas. The inven- 
tory should include: TlFA's, buffalo turbines, dusters, 
mixers, sprayers, rat traps, bait stations, respirators, 
masks, cartridges, coveralls, and protective gloves. 

(2) Maintain a running inventory of all equip- 
ment and a locator index. 

(3) Instruct supervisors and workers at frequent 
intervals to make good use of this equipment, which 
should be in use as much as possible while a need 
exists. If an apparatus is not being used by one team 
for the time being, it should be reassigned. 

(4) Protective helmets are advised when work- 
ing in disaster areas. 

c. Personnel 

( 1 ) Determine how many personnel are available 
for pest control work and the nature of their training 
and capabilities. 

(2) Assemble them at a briefing session, explain 
what must be done, what priorities are necessary, and 
how important the work is. Job motivation should be 
stimulated as often as possible by such methods. 

(3) Procure protective coveralls and helmets for 
all personnel and stencil the gear with an appropriate 
designation such as "PWC PEST CONTROL." Dis- 
tribute the gear to the operators and supervisors. Use 
of such a uniform will simplify access to disaster areas 
and permit rapid identification of team members. 



d. Surveys and Map Plotting 

( 1 ) Procure several maps of the disaster area 
and, with the aid of personnel who know the area, plot 
dumps, both military and civihan, local health centers 
and hospitals, swamps and other potential insect- 
breading places, location of tent camps and field 
kitchens, and any other areas that may be a source of 
sanitation problems. 

(2) Start a general survey for trouble areas by 
using trained sanitation personnel for the task; local 
sanitarians and others may be used as guides. Infor- 
mation should be plotted on the map; plastic overlays 
may prove useful for this, if available. 

(3) Break the area into designated subareas and 
assign a sanitation team to each area for a more de- 
tailed survey. 

(4) As information is received, collated, and 
plotted from the detailed surveys, send pest control 
crews into trouble areas under supervision of sanitation 
personnel to direct their eff'orts in treating these areas. 

(5) Keep a standby crew of pest control person- 
nel and power sprayer equipment for dispatch to any 
area that may need immediate emergency treatment. 

(6) As survey data accumulate, exchange infor- 
mation with the public works department so that 
duplication of effort may be kept at a minimum. 

(7) During any survey, ascertain what conditions 
existed before the disaster so that a comparison may 
be made of the extent of the problem before and after. 
Many times, persons become acutely aware of a con- 
dition that has always existed but which assumes new 
prominence in time of stress. Often these preexisting 
problems, with low priority for rectification, may now 
be aggravated to such a degree that top priority is 

e. Operations 

(1) Pest control operations will require intensifi- 
cation of normal routine procedures for the most part. 
Fogging should be done only if a need exists. Deter- 
mine if mosquitoes are really disease vectors or simply 
pests. Strong pressure will be exerted to fog because 
everyone is used to seeing "Smoky Joe" in the area. To 
fog just for this reason is a waste of personnel and 
insecticide which are critical at this time. These facts 
should be thoroughly explained to the Health Officer 
and public works officials. 

7. Miscellaneous Operations. 

a. Report to the health officer, the medical officer, 
the commanding officer(s), the public works officer 
and the public works foremen daily. Often this can be 
accomplished at one of the daily conferences of the 
commanding officer. Continuously emphasize the need 
to have complete control of sanitation and pest control 
operations at the Sanitation Command Post. Sugges- 
tions should come from the commanding officer via the 
health officer only. 

b. If the local radio station is operating, or upon 
resumption of operation, it is recommended that broad- i , 
cast be made daily of short bulletins on health and -^ 
sanitation pratices, and to acquaint the public of actions 
instituted to prevent outbreaks of disease. Telephonic 

or personal interviews with the officer-in-charge of 
the Sanitation Command Post are useful in preventing 
exaggerations and misrepresentations of health condi- 

c. Short bulletins and handouts for publication and 
distribution on such subjects as water supply, slit 
trenches, burial of waste and garbage, burning of 
refuse, etc.. will prove helpful in maintaining good 
sanitation, good public interest and co-operation. 


Morbidity and Mortality Weekly Rept., HEW, Com- 
municable Disease Center, Atlanta. Ga., 13(39): 
338-343. October 2. 1964. 

During 1963, 76 cases of psittacosis in humans were 
reported. Seventy-nine cases were reported in 1962; 
this is approximately one-half the annual number re- 
ported 5 years ago, and only 13% of the total human 
cases recorded in 1954. 

The 1963 cases occurred in 19 States. A majority of { 
the total cases were reported by 3 States: Texas (17), -^ 

California (14), and Illinois (II). 

To date this year, there are 35 cases of psittacosis 
reported. California has the largest number of cases 
of any State with 13 (37%). 

The histogram in the original of the above referenced 
article represents the number of reported cases each 
year since 1949, with peak incidence occurring in 1956 
with 568 cases. The large number of cases reported 
in 1954 and 1955 is believed due primarily to recogni- 
tion of cases acquired from commercial poultry. 

Epidemiologic data has been obtained by the Com- 
municable Disease Center on the source of infection 
for 1,270 of the 2,418 human cases of psittacosis which 
have occurred since 1954. Parakeets were the source 
of infection in 747 cases. They are the traditional 
source of most human infections; however, they do not 
account for the increased number of cases recorded 
during the early years of this period. Data studied 
suggest that at least part of the increased incidence of 
psittacosis was due to recognition of cases acquired 
from infected fowl. 

When the human cases were grouped by exposure 
category, pet bird breeders, dealers and owners ac- 
counted for 579 of the 1,290 investigated cases while 
an additional 370 cases occurred among poultry ^^ 
processors. These individuals were exposed to infected f 
turkeys or other domestic fowl. 



The only significant common-source outbreak during 
1 963 occurred in Texas where at least 1 I of the 1 7 
reported cases occurred in individuals exposed to 
ornithosis-infected turkeys in a poultry processing plant. 
Between April 21 and May 27, 1963, 1 1 employees of a 
small turkey processing plant became ill with mild 
symptoms including chills, dry cough, chest pains, gen- 
eral malaise, and fever to 102°F. Complement fixation 
tests confirmed the diagnosis of psittacosis. Eight of 
these cases had onset dates between April 21 and April 
28, 1963; 3 cases had onset dates between May 24 and 
May 27, 1963, thus indicating that there were 2 separate 
exposures, roughly one month apart. Epidemiologic 
investigation by the Texas State Department of Health 
traced the outbreaks to 2 separate infected turkey 
flocks, one processed on April 1 1 and the second on 
May 14. 

The isolation of the causative agent in 1930, coupled 

with numerous epidemics with a high case-fatality 
ratio, led to regulations controlling the importation of 
parrots, and later all psittacine birds into this country. 
Since then, the discovery of many new avian hosts and 
related etiologic agents has increased the epidemiologic 
complexity of the disease. At the same time, the in- 
troduction of antibiotics and effective control measures 
has reduced the public health significance of this 

General Order Nv. 20 — "Medical and Agricultural 
Foreign and Domestic Quarantine Regulations for 
Vessels, Aircraft and Other Transport of the Armed 
Forces," of 12 May 1962, Section VI, (of interest to 
those persons moving to and from overseas) permits 
transport of Psittacine birds on Military Sea Trans- 
portation Service ships and Military Air Transport 
aircraft when certain conditions are met. 


Richard D.. James. Wall Street Journal, SW Edition, XXXIIl(1 14): I, 13, June 9, 1964. 

Thirteen people who ate eclairs purchased from a 
Detroit bakery became seriously ill with cramps and 
other symptoms of food poisoning, investigators found 
that water polluted with salmonella germs was used to 
process some poultry feed, infecting chickens who 
passed the bacteria to eggs which wound up in the 
bakery's eclairs. 

Outbreaks of salmonellosis and some other forms of 
food poisoning have increased sharply in recent years, 
causing growing concern among public health officials 
and the food industry. As a result, scientists are step- 
ping up efforts to understand and possibly prevent out- 
breaks. Federal and state health officials also are 
tightening regulations and increasing supervision of 
food processors. And the food industry is intensifying 
its own policing of standards. 

Food poisoning cases reported to the U. S. Public 
Health Service last year totaled 16,800, well above the 
9,500 of the previous year and the 1 0,000-a-year aver- 
age of the past decade. While part of the gain is due 
to better local reporting of cases, some portion rep- 
resents an actual increase, officials say. The reasons 
for the increase are far from clear. 

Peril of Mass Production. Doctor Lawrence K. 
Altman, epidemiologist at the Communicable Disease 
Center of the PHS, suggests that the growth and com- 
plexity of the food industry partly explain the increase. 
"There is far more mass-produced food than ever be- 
fore and if something is contaminated, more people 

will fall victim to it," he says. "As the food industry 
becomes larger, there are more food handlers, in- 
creasing the chance for carelessness. Food processors 
may buy from more suppliers— more farms — which 
could provide a greater source for germs, too." 

The true total of food poisoning undoubtedly is far 
higher than reported cases, officials say. Many an 
upset stomach thought to be flu or indigestion may ac- 
tually be a mild case of food poisoning. Estimates of 
the true total run anywhere from 200,000 to more than 
1 million cases a year in the United States. 

The under-reporting of food-borne illness is illus- 
trated by figures for salmonella poisoning. Officially, 
there were 2,300 cases last year caused by food con- 
taining the germ, up sharply from 1,513 in 1962 -and 
only 750 in 1961. But a great many more cases of 
salmonellosis couldn't be linked definitely to food, 
though officials say food is a likely source. Total 
cases last year numbered 18,000, almost double the 
year earlier level. 

Most disturbing of all to health authorities is the 
appearance in commericai foods of a rare and life- 
threatening form of poisoning called botulism. Nine 
deaths last year were traced to commercial tuna and 
smoked whitefish contaminated with the botulinum 
germ's toxin. 

Worst Year Since 1925. "No explanation can be pro- 
vided for the sudden occurrence of commercial (botu- 



lism) outbreaks during 1963," says the Communicable 
Disease Center of the Public Health Service. Last 
year's nine fatalities were the most since 1925 and well 
above most pre-1925 years when less stringent com- 
mercial canning standards were observed. The deaths 
were among 24 cases of botulism linked to commercial 
foods, two more than the total caused by home-pre- 
served foods. Officials note this reversed the pattern 
of previous years when "the vast majority" of botulism 
cases stemmed from home canning of foods such as 
green beans and corn. 

A food poisoning incident can have devastating eco- 
nomic impact, at least temporarily. A can of com- 
mercial tuna, packed for a supermarket chain by an 
independent West Coast concern, is believed to have 
caused the botulism deaths of two Detroit housewives 
last year. News of the deaths caused the nation to 
suddenly lose its appetite for tuna and the average 
wholesale price slumped to $10.60 a case from $12.50. 
Dollar sales for 1963 fell to about $175 million from 
1962's record $210 million, the industry estimates. 
However, sales this year are running 10% to 15% 
ahead of the year-ago period. 

Other segments of the food industry realize the same 
thing could happen to them. "It's a dollars-and-cents 
proposition, not an altruistic matter on our part," says 
the chief microbiologist for a large meat packer, de- 
scribing his company's fight against one type of food 
poisoning. "All we'd need would be one case traced to 
our products," 

Botulism is fatal in at least half of all cases. The 
toxin, or poison, which causes it is produced by the 
botulinum germ, Clostridium botuUnum, when it grows 
on food in the absence of oxygen. Thus, a vacuum- 
sealed can is an ideal environment. Cooking, however, 
destroys the toxin. 

Tracking Down Type E Germs. Scientists are work- 
ing hard to learn more about the ailment, which at- 
tacks the nervous system. One of the puzzling things 
under investigation is the number of cases of type E 
botulism, one of five varieties. Before 1963 there were 
only 36 cases on record, but last year alone there were 
22, all related to commercial fish products. 

The U.S. Food and Drug Administration recently 
contracted with Oregon State University and the Uni- 
versity of Wisconsin to determine the source and 
prevalance of type E germs. Wisconsin scientists thus 
far have netted about 500 chubs, perch and other Great 
Lakes fish, and taken over 200 mud and water samples 
in the search for the bacteria. Meanwhile, FDA's own 
researchers are trying to understand how different food 
environments affect the growth of the bacteria. The 
agency has assigned three full-time microbiologists to 
the project. 

At a research center of a large can company, scien- 
tists also are studying how type E germs behave in 
various environments. They hope to learn the exact 

conditions under which the bacteria grow and then ap- 
ply the findings to safer types of packaging. "We're ^^J 
?lso testing various chemicals in hopes of finding one 
that could be injected into fish, for example, to prevent 
the organisms from growing and producing toxin," says 
an official. 

Other companies are tightening quality controls. The 
assistant general manager of a Chicago frozen fish pro- 
duction firm says, "Plant superintendents, foremen and 
quality control people have been told they'll be fired if 
they don't follow sanitary regulations to the letter, 
whereas before they might get by with a warning. In 
addition, we've added 10 more quality control clerks 
and we're running checks on finished samples every 
half hour instead of every hour." 

In California, one of the centers of the canning in- 
dustry, companies have added extra employees to in- 
spect can seams, reports John E. Hammer of the state's 
bureau of food and drug inspection. "Some small fish 
processors now are inspecting seams once an hour com- 
pared to once or twice a day" before the botulism 
cases, he says. "Big plants are inspecting every five 
minutes compared to once an hour previously." One 
reason is the theory that botulinum bacteria from un- 
known sources entered tuna cans last year through 
faulty or broken seams, probably after the sealed cans 
left the sterilizing temperatures of the retort where the 
tuna was cooked. 

Government regulatory agencies, too, are enforcing ' 
stricter controls. The FDA now requires all Great 
Lakes fish smokers to freeze their product. Distribu- 
tion of the fish in frozen form is considered safe be- 
cause the botulism toxin is not known to develop at low 
temperatures, the FDA says. Smoked Great Lakes 
whitefish— not in frozen form — is blamed for seven of 
last year's nine botulism deaths. In five of the cases, 
the whitefish was packed in vacuum-sealed plastic bags 
and was part of a single shipment to a supermarket 

New Michigan Rules. The state of Michigan also has 
drawn up its first regulations for processing smoked 
fish. The new rules require processors to have proper 
recording equipment to show that prescribed times and 
temperatures are followed. They also forbid vacuum 
packaging unless the product is processed to kill any 
germs and prevent the production of toxin in the 

A similar determined attack by industry and regula- 
tory agencies is being directed at salmonellosis. Sal- 
monella germs are widespread in livestock and poultry 
flocks. Concern was heightened recently when 900 
patients in 59 hospitals in 16 states contracted the dis- 
ease through eggs served raw or undercooked to those 
on special diets. 

Health officials believe that the infection often begins ^^ 
with germs in raw meat scraps and fish meal that go \ 
into animal feeds. Feed manufacturers and their sup- 



pliers are voluntarily taking steps to clean up feeds. 

Ralston Purina Company recently completed an in- 
tensive analysis of ingredients from all suppliers to 
determine if there was any contamination, a step never 
undertaken before, according to Doctor Charles F. 
Rossow, manager of Ralston's microbiology section. 
An undisclosed number of suppliers were found to have 
salmonella problems. Ralston hasn't stopped buying 
from them yet. "These suppliers have been warned 
that they do have a problem; we've asked what they're 
doing to correct it and we're working to help them." 
says Doctor Rossow. 

The main problem facing renderers and fish meal 
producers is recontamination of ingredients which are 
sterile after they're processed. "We keep the raw 
ingredients and the finished product entirely separate," 
says an official of an East Coast rendering company. 
"Workmen going between areas must scrub off their 
footwear, wash their hands and change coveralls. We 
also have separate sets of clean-up tools, like brooms 
and shovels, for each area; we even painted the set in 
the processed area white so there'll be no mix-up." 

Salmonella Testing Begun. The Agriculture Depart- 
ment is working with companies and state health officers 
to set up a voluntary testing program to systematically 
screen samples of feed and feed ingredients to detect 
salmonella bacteria. The program began earlier this 
year on a limited scale in some Southern states. "We 
hope to have it operating nationally by the end of 
the year," says Doctor John Walker of the USDA's 
animal disease eradication division. 

Vigilance against staphylococcal food poisoning also 
is increasing. Staph infections carried by food are, 
along with salmonellosis, among the commonest kinds 
of food poisoning. Staph outbreaks typically occur at 
large social gatherings where food is prepared in ad- 
vance and allowed to stand at room temperature. In 
five hours on a summer day staph germs can produce 
enough toxin to cause illness. 

The number of reported cases has averaged about 
1,700 a year for the past few years, but "this probably 
represents only about one-tenth of the actual number," 
says Doctor Philip S. Brachman, chief of the Com- 
municable Disease Center's investigations section. 


Did You Know? 

That the Government of Bolivia is undertaking a 
2-year campaign against foot and mouth disease? 

In the 23,000-square-miIe Cochabamba Province, 
20,000 cattle will be vaccinated with a new, weakened 
live virus developed by the Pan American Foot and 
Mouth Disease Center in Brazil. This vaccine will give 
protection much longer than the killed virus vaccines 
in present use. The Pan American Sanitary Bureau, 

WHO Regional Office for the Americas, will assist in 
the project. ( 1 ) 

There were 9,320 cases of viral hepatitis reported 
in the United States in the spring quarter of the epi- 
demiological year 1963-64. 

A total for that reported year (1963) was 40,657 
cases with an incidence of 21.6 per 100,000 population. 
This total of reported cases and incidence was the 
lowest reported since the peak year 1960-61. (2) 

That deaths from chronic pulmonary emphysema, a 
crippling lung disease, have more than quadrupled in 
the last 10 years? 

So reported the Chief of the Division of Chronic 
Diseases of the Chest to the International Congress on 
Diseases of the Chest, held in Mexico City, on 1 3 
October 1964. While tuberculosis has declined sharply 
as a killer and crippler, lung cancer has shown a strong 
increase and a group of nonspecific respiratory condi- 
tions have emerged, killing 27,000 Americans and 
hastening the death of another 43,000 in 1962. (3) 

That water and sewer bond sales by State and local 
governments in the United States totaled at least 
$1,319,000,000 in 1963? 

"The Water and Sewer Bond Sales in the United 
States, Jan-Dec 1963," report, recently released, further 
states that in 1963, bonds for financing water facilities 
totaled $614 million, and for building sewage treatment 
facilities and sewers amounted to $524 million. 
Another $182 million in bonds were used in combina- 
tion projects for both water and sewerage construction. 
California led all other States with a total of $280,- 
774,000 bonds sold. (4) 

That there are over 4,000 cancer quacks in the 
United States and the American public spends approxi- 
mately $10,000,000 a year for their ministrations? 

Since 1960, the California State Department of 
Health has been enforcing the Cancer Antiquackery 
law adopted by the California State Legislature in 
1959. (5) 

That 60,000 narcotic addicts in the United States 
are responsible for the waste of $450,000,000 a year 
and that $350,000,000 alone are spent on illegal drugs? 

The American Social Health Association reported 
recently that the typical male addict steals $30,000 to 
$90,000 in merchandise or money in a year's time 
while the female addicts usually resort to prostitution 
to obtain money to support their use of narcotics. (6) 

That the world total of smallpox cases of 92,761 in 
1963 exceeded the annual average number of cases for 
the years 1959-1963 by 16,527 cases? 

The total number of deaths reported in 1963 
(24,530) exceeded the annual average for the same 
period world-wide by 8,199 deaths. (7) 




1. WHO Chronicle, 18(9): 356, Sept 1964. 

2. DHEW PHS CDC Hepatitis Surveillance Report 
No. 20: 1, Sept 30, 1964. 

3. DEHW PHS Div Chronic Dis, Press Release. 
HEW-678, Oct 13, 1964. 

4. DHEW PHS Professional Release & PHS Publica- 
tion No. 965, 1963 Edition. 

5. Los Angeles Co. Health Index, Los Angeles Co. 
Health Department, Sept 5, 1964. 

6. 'This is ASHA" p. 6, Sept 1964, published by the 
American Social Health Association, Inc., 1790 
Broadway, New York 19. New York, to present its 
Program and Services. 

7. WHO Chronicle. 18(10): 376-379. Oct 1964. 

parlors. The owners were consulted as to the best time V^ 
of day for the training and the number of hours that 
could be spent on it. They were enthusiastic about 
the possibility of training and sincere in the desire to 
improve their methods. 

When the classes were presented, there was a pleasant 
surprise — every tattoo artist in the county, 30 in ail, 
appeared. All came back on the second day. 

The first day's program began with introductory re- 
marks by the Director of the Department. It included 
films on the infectious process, a lecture on bacteri- 
ology, and a lecture by the Chief of the Bureau of 
Laboratories on the use of the autoclave. The second 
day's program dealt with sterile procedures and the 
supplementary regulations for tattoo parlors. 

The following week, sanitarians inspected the parlors 
to evaluate the training. Each of the artists was taking 
an active interest in employing the new sterile pro- 
cedures. The operators had even experimented and 
learned how to autoclave the dyes without destroying 
them. No infected tattoos have been traced to San 
Diego tattoo parlors since then. 


Health Officers NEWS DIGEST. XXX(9): 11-14, 
Sept 1964. 

As a seaport and headquarters of the Eleventh Naval 
District, the city of San Diego has many tattoo parlors. 
These parlors are under regular inspection by the Divi- 
sion of Sanitation of the San Diego County Department 
of Public Health. Ordinances in the Municipal Code 
specify that tattoo artists sterilize their instruments and 
sterilize the skin before applying a tattoo. However, a 
few years ago the Department received a report from 
the Medical Officer of the Naval District concerning 
infected tattoos among Navy recruits. 

The Division of Sanitation conducted a special sur- 
vey of the situation. Tattoo ordinances were reviewed, 
and tattooing methods in use were studied in detail. 

The survey revealed that the tattoo artists were 
trying to do the right thing, but the ordinances were 
not specific enough to give them infallible guidance. 

More specific supplementary regulations were pre- 
pared. But the Chief of the Division of Sanitation felt 
that regulations alone would be inadequate; that the 
tattoo artists must thoroughly understand the problem 
of possible infection at every point in their procedure. 
He suggested an educational approach similar to the 
food handling classes which have been so successful 
with restaurant personnel. 

A supervising sanitarian was assigned to develop a 
two-day training program for tattoo artists, the first 
such training program in the Department's history. 
The classes were planned with the Department's Bureau 
of Public Health Education and owners of the tattoo 



H.E. Sigerist, MD: A History of Medicine, Oxford 

Pub. N.Y., 1961 Medical Director's Notebook, 

Sept. 1964 

From a Persian ins. ca. 250 B. C. 

"A healer shall heal a priest for a holy blessing; he 
shall heal the master of a house for the value of an ox 
of low value; he shall heal the lord of a borough for 
the value of an ox of average value: he shall heal the 
lord of a town for the value of an ox of high value; he 
shall heal the lord of a province for the value of a 
chariot and four (horses). 

"he shall heal the wife of the master of a house for 
the value of a she-ass; he shall heal the wife of the 
lord of a borough for the value of a cow; he shall heal 
the wife of the lord of a town for the value of a mare; 
he shall heal the wife of the lord of a province for the 
value of a she-camel. 

"He shall heal the son of the lord of a borough for 
the value of an ox of high value; he shall heal an ox 
of high value for the value of an ox of average value; 
he shall heal an ox of average for that of an ox of low ^^ 
value; he shall heal an ox of low value for the value of ' 
a sheep; he shall heal a sheep for the value of a meal 
of meat." 





The Bureau of Medicine and Surgery has been noti- 
fied by the American Board of Internal Medicine that 
the following Reserve Officers have been certified: 

LCDR Stanley R. Finke MC USNR 626860/2105 

LCDR Joseph A. Glennon MC USNR 625208/2105 
LCDR Richard J. Greenwood MC USNR 616820/2105 
LCDR James C. Jordan MC USNR 624026/2105 

LCDR Marvin A. Leder MC USNR 625591/2105 

LCDR Harvey L. Lerner MC USNR 625512/2105 

LCDR John T. Magee MC USNR 625607/2105 

LT Michael A. Manko MC USNR 604489/2105 

LCDR William E. Mayberry MC USNR 568150/2105 
LCDR John C. McGifT MC USNR 495633/2105 

LT Murray J. Miller MC USNR 618952/2105 

LT Arthur J. Moss MC USNR 625423/2105 

LT Thomas J. Pekin, Jr., MC USNR 582260/2105 
LT Fredric Reichel MC USNR 625409/2105 

LCDR Oscar W. Shapiro MC USNR 6 1 1 373/2 1 05 

LCDR Alton R. Sharpe, Jr., MC USNR 589140/2105 
LCDR Frederic F. Taylor MC USNR 587582/2105 
LT Lawrence Troum MC USNR 616669/2105 

LT John Arthur Winter MC USNR 567164/2105 

BUPERS INSTRUCTION 1571.20D 5 October 1964 

Subj: Active Duty for Training with Pay for Non-Pay 
Personnel (Pay Group D) 

1. Purpose. To promulgate guidelines for active duty 
for training for personnel in non-pay status. 

2. Cancellation. BuPers Instruction 1571.20C 
(NOTAL) is cancelled. 

3. Background. The cost of maintaining the paid 
drilling portion of the Selected Reserve has continued 
to increase and must continue to receive first priority 
for paid active duty for training. In addition, the 
onboard strength of the Selected Reserve has been near 
the limiting ceiling imposed by the Secretary of Defense 
so that funds utilized in the past to divert to the pay- 
ment of active duty for training for non-pay personnel 
are not presently available. The Secretary of Defense 
has established a ceiling on the number of officer and 
enlisted personnel in a non-pay status who may per- 
form active duty for training with pay and further 
stipulated that officers in a non-pay status being 
ordered to two weeks active duty for training with pay 
must be assigned a mobilization billet to which they are 
scheduled to report within M-f90 days. This restric- 
tion was not extended to enlisted personnel. 

NOTE: This Instruction continues with Quotas, Guide- 
lines, and Action. 

A survey has shown that in the USA more than 400,000 children, including 13,000 under 6 years of age, are 
left to their own devices while their mothers go out to work. This situation is paralleled in many other countries, 
and the expansion of day-care services for children is being increasingly recognized as a public responsibility. — 
WHO Chronicle 18(10): 364, October 1964. 

During 1963 more people contracted smallpox and more people died from it than in any year since 1958. This 
does not, however, mean that the world-wide smallpox eradication campaign is proving ineffective, but simply that 
it has not yet reached a stage at which its influence can be reflected in the overall incidence figures.— WHO 
Chronicle 18(19): 376, October 1964. 






#18 28 June 1965— July 1966 


15 Janury 1965 


Top Secret 

Mission: It is the mission of the NSMO Course to provide the opportunity for a limited number of selected Army, 
Navy and Air Force Medical Officers to acquire the additional technical education needed to cope with the radio- 
biological problems involved in all phases of the National nuclear energy program. 

Scope: The course provides for a review of selected portions of mathematics and physics during the refresher 
phase, followed by a full academic year of graduate study involving radiological physics, health physics, biologi- 
cal effects of radiation, evaluation of radiation hazards, environmental hygiene and toxicology, and as electives, re- 
lated areas of industrial medicine and radiology. Completion of the academic phase at acceptable performance 
levels can lead to a Master's Degree in Radiation Biology, in one year for those entering with doctoral degree 
and upon completion of additional research or special studies for those not having previous professional training. 
The academic phase is followed by a study of practical military nuclear medicine. During the course the medical 
aspects of nuclear radiation over the complete range of intensity levels from low-level, peacetime laboratory situa- 
tions through high-level, full scale nuclear warfare situations are discussed. 






PHASE HI (4 weeks) 


Eligibility: The course is primarily designed for officers of the Medical Corps. However, officers of the Medical 
Service Corps, in very closely allied medical fields who have had some graduate work beyond the B.S. degree may 
also be eligible for selection. 

Requests should be forwarded in accordance with BUM ED INSTRUCTION 1520.1 OB and comply with the 
deadline date as indicated above. All requests must indicate that a security clearance of TOP SECRET has been 
granted to the officer requesting attendance, or that action to obtain clearance has been initiated. 
— Training Branch, Professional Division, BUMED. 





A host of high-ranking military and civilian medical 
personnel attended the formal presentation of the new 
organizational flag to the Armed Forces Institute of 
Pathology at the Institute, September 1 6. 

During the ceremony, the AFIP was also awarded 
the Air Force Outstanding Unit Award for "exception- 
ally meritorious service of both national and interna- 
tional significance." The award was presented by Maj. 
Gen. Richard L. Bohannon, Surgeon General of the 
Air Force. 

The flag, designed by the Army Institute of Heraldry, 
was presented to the AFIP Board of Governors by Dr. 
Shirley C. Fisk, Deputy Assistant Secretary of Defense, 
Health and Medical. The Institute's Board of Gov- 
ernors, composed of the Surgeons General of the Army, 
Navy and Air Force, was represented by Rear Admiral 
E. C. Kenney, Surgeon General of the Navy, and Maj. 
Gen. Richard L. Bohannon, Surgeon General of the 
Air Force. Brig. Gen. Conn L. MUburn, Deputy 
Surgeon General of the Army, represented Lt Gen. 
Leonard D. Heaton, Chairman of the Board and 
Surgeon General of the Army. Also attending the cere- 
mony was Dr. Luther L. Terry, Surgeon General of the 
U. S. Public Health Service. 

The brief ceremony was opened by the U.S. Army 
Band and a tri-service color guard. AFIP Director 
Brig. Gen. Joe M. Blumberg gave the formal welcome 
and introduced Dr. Fisk, who presented the flag. CDR 
Robert E. Brengartner, Chaplain of the National Naval 
Medical Center, delivered the invocation and the bene- 
diction was given by Chaplain (Col.) Roy A. Morden, 
Chaplain of the Walter Reed Army Medical Center. 

The presentation was given added color by the dis- 
play of the 54 state and territorial flags in front of the 

AFIP building where the ceremonies were held. In ad- 
dition to Dr. Fisk and the Surgeons General, more than 
a score of other officials from the Defense Department, 
the offices of the Surgeons General and several other 
military and governmental installations in the Washing- 
ton area attended. 







"For meritorious service on 5 January 1964 while 
serving at the Station Hospital, Headquarters Support 
Activity, Saigon, Republic of Vietnam. Upon learning 
that friendly casualties were heavy among two bat- 
talions that were engaged in battling the enemy in the 
vicinity at Tan An, Lieutenant Stone, in order to 
render assistance to the wounded, volunteered to ac- 
company several armed helicopters which were taking 
off for the area. Although the helicopters could not 
land due to the intensive ground fire, he remained 
with them on several subsequent missions in an attempt 
to land in ground troop positions. On one mission he 
was painfully wounded in the chin, but continued opera- 
tions with the helicopters until its forced return because 
of battle damages. Upon landing, he aided in treating 
a seriously wounded crew member of another helicopter 
before allowing himself to be treated. Lieutenant Stone's 
inspiring and selfless devotion to duty in the face of 
hostile fire reflects great credit upon himself and the 
naval service." 

The Combat Distinguishing Device is authorized. 


Flocks of chickens serve as sentinels against any 
sneak attack by encephalitis in New Mexico. The vec- 
tor control section of the State health department sets 
mosquito traps within special chicken pens to permit 
collection of live mosquitoes for weekly identification 
and virus isolations. Chickens are bled monthly for 
antibody determination. Thus an early alert may be 
expected if the encephalitis virus becomes active; 
knowledge of the species carrying the virus, in case it 
appears, will also be obtained. — Public Health Reports 
79(10): 924. October 1964. 


The Maryland State Department of Health has 
established a counseling and referral service to help 
the large number of draft-age youths who are rejected 
for military service because of physical reasons. Pur- 
pose of the program is to promote early diagnosis of 
health problems and encourage the youths to seek 
medical care promptly, thus alleviating medical, voca- 
tional, and social difficulties.^Public Health Reports 
79(10): 924, October 1964. 




Two of the four papers on medical topics during the 
half day devoted to medical research at the West Coast 
Research Reserve Seminar held at San Diego, 19 and 
30 October, were read by regular Navy medical officers. 
CAPT F. W. George, of the U.S. Naval Hospital, San 
Diego, reviewed recent technical advances in radiolog- 
ical therapy. Commander Ransom Arthur, Officer in 
Charge of the Medical Neuropsychiatric Research 
Unit, presented recent results of research in neurology 
and psychiatry. He called attention to the unusual 
opportunities for research on some diseases made possi- 
ble in military environments because the Navy does not 
lose track of men after diagnosis and treatment and 
can thus accurately follow up to obtain an unbiased 


Limitations on Department of Defense personnel 
accepting ''any favor, gratuity, or entertainment" have 
been defined more precisely by a modification of the 
Department's directive on "Standards of Conduct." 

The Previously effective paragraph on the subject, 
in Department of Defense directive Number 5500.7 
dated May 17, 1963, reads as follows: 

"DoD personnel will not accept any favor, gratuity, 
or entertainment directly or indirectly, from any person, 
firm, corporation, or other entity which has engaged, 
is engaged, or is endeavoring to engage in procurement 
activities or business transactions of any sort with any 
agency of the DoD, where such favor, ^ratuily, or 
entertainment might affect, or might reasonably he 
interpreted as affecting, or give the appearance of 
affecting the objectivity and impartiality of such person- 
nel in servicing the Government." 

Experience over the past year has indicated that the 
discretionary language (italicized in the paragraph 
above) used in this section of the directive has been 
variously interpreted by Defense personnel and in 
some cases has resulted in action considered inconsistent 
with the spirit and intent of the directive. This section 
of the directive has been modified to read as follows: 
"VI. Gratuities 

A. DoD personnel will not accept any favor, 
gratuity or entertainment directly or indirectly, from '^^ 
any person, firm, corporation, or any other entity 
which has engaged, is engaged, or is endeavoring to 
engage in procurement activities or business transac- 
tions of any sort with any agency of the DoD except 
as provided in Paragraphs I, 2 and 3 of this section. 
Favors, gratuities, or entertainment bestowed upon 
members of the immediate families of DoD personnel 
are viewed in the same light as those bestowed upon 
DoD personnel. Acceptance of entertainment, gifts, 
or favors (no matter how innocently tendered or re- 
ceived) from those who have or seek business dealings 
with the Department of Defense may be a source of 
embarrassment to the Department and to the personnel 
involved, may affect the objective judgment of the 
recipient and impair public confidence in the integrity 
of business relations between the Department and 

1. In some circumstances the interests of the Gov- 
ernment may be served by participation of Defense 
personnel in widely attended lunches, dinners and 
similar gatherings sponsored by industrial, technical 
and professional accociations for the discussion of 
matters of mutual interest to Government and industry. 
Participation by Defense personnel is appropriate where 
the host is the association and not an individual con- 
tractor. However, acceptance of entertainment or hos- . 
pitality from private companies in connection with such ' 
association activities is prohibited. 

2. In some circumstances the interests of the Gov- 
ernment may be served by participation of Defense 
personnel in activities at the expense of individual 
Defense contractors. These activities include public 
ceremonies of mutual interest to industry, local com- 
munities and the Department of Defense, such as the 
launching of ships or the unveiling of new weapons 
systems; industrial activities which are sponsored by 
or encouraged by the United States Government as a 
matter of United States defense or economic policy, 
such as sales meetings to promote ofT-shore sales in- 
volving foreign industrial groups or governments; and 
luncheons or dinners at a contractor's plant, on an 
infrequent basis, where the conduct of official business 
within tiie plant will be facilitated and where no provi- 
sion can be made for individual payment, 

3. There may be a limited number of additional 
situations where, in the judgment of the individual 
concerned, the Government's interest would be served 
by participation by Department of Defense personnel 
in activities comparable to those enumerated above. In 
any such cases in which Department of Defense person- 
nel accept any favor, gratuity or entertainment directly 
or indirectly from any person, firm, corporation, or 
other entity which is engaged in business transactions , 
of any sort with the Department of Defense, a report 

of the circumstances will be made within forty-eight 



hours to the designee of the Secretary of the miUtary 
department concerned, or to the designee of the Secre- 
tary of Defense in the case of Department of Defense 
personnel not within one of the miUtary departments. 

The amendment, signed by Deputy Secretary Cyrus 
R. Vance on September 25, 1964. will be included in 

the reissue of the Directive. All other sections of the 
basic directive remain the same. 

(Copies of the reissue of DoD Directive 5500.7, up- 
dated to September 25, 1964, are now available at 
Defense News Branch. Room 2 E 757a, Pentagon.) 


The following slide sets are availble on a two-week 
loan basis from the Medical Illustration Service, 
Armed Forces Institute of Pathology: 

L-2726 Comparative Study of Four Cases of Total 
Body Radiation, consisting of 46 lantern 

slides, with 25 sets available for loan. 

L-6364 Lesions of the Uterine Cervix, consisting of 
95 lantern slides, with 25 sets available for 

L- 1 1 063 The Pathology of Metazoan Parasitic 
Diseases of Man and Animals, consisting of 
224 lantern slides, with 25 sets available for 


An analysis by the Chicago Board of Health revealed 
that 72 percent of deaths in that city among infants 
7 days to I year of age during 1961 occurred in the 
lowest socioeconomic area. Here the infant mortality 
rate was 50 percent higher than the city average; also, 
92 percent of these deaths resulted from acute infec- 
tions. Because dietary deficiency of mothers during 
pregnancy and infants during the first year of life was 
considered a possible factor, the board of health has 
undertaken a controlled study of the possible effect of 
feeding infants a prepared formula containing 12 mg 
of iron per quart. In the study, scheduled for comple- 
tion in 1964. 1,000 infants are to be followed for 18 
months each.— Public Health Reports 79(5): 392, 
May 1964. 


Reporting that there are approximately 12,000 
buffalo on about 400 separate ranges in the United 
States, the U.S. Department of Agriculture proposed 
controls on interstate movement of the animals to 
check the spread of brucellosis. Many small buffalo 
herds, the Department said, contain infected animals 
that could spread brucellosis to cattle. — Public Health 
Reports 78(12): 1060, December 1963. 


More than 141 million Americans, 3 of every 4 of 
the civilian population, had some form of health insur- 
ance protection through voluntary insuring organiza- 
tions in 1962. The "Source Book of Health Insurance 
Data, 1963," published by the Health Insurance Insti- 
tute, 488 Madison Ave., New York, N.Y., describes 
this as an increase of nearly 5 million persons with 
health insurance over the previous record high of 
1961.— Public Health Reports 79(5): 392, May 1964. 

It was recently estimated that throughout the world hookworms still cause a daily blood loss equivalent to the 
total exsanguination of about 1.5 million people.~WHO Chronicle 18(10): 369, October 1964. 

The investigation of an epidemic of yellow fever that caused 15,000 deaths in Ethiopia between 1960 and 1962 
has revealed two main routes of entry of the virus into a country hitherto free from disease. — WHO Chronicle 
18(10): 390, October 1964. 

Anticancer drugs were until recently reserved for the treatment of leukaemias, haematosar comas and certain rare 
tumours, such as choriocarcinomas, seminomas, and myelomas. In the last two years they have been applied 
with some modest success in the treatment of far more common tumours, such as those of the gastro-intestinal 
tract, the lung, and the cervix uteri. — WHO Chronicle 18(10): 393. October 1964. 




Orchard View Community Schools in Muskegon 
Township, Mich., have installed seat belts for drivers 
on each of the district's 1 7 school buses.— Public Health 
Reports 79(10): 924, October 1964. 


In southeastern Michigan, 275 active cases of tuber- 
culosis were discovered in tuberculin tests of 800,000 
school children from September 1957 to December 
1962. About 1.7 percent of the children were reactors. 
In 33,745 contacts of the reactors, an additional 1 1 6 
new cases were found through X-ray. — Public Health 
Reports 79(10): 924, October 1964. 


Forty-six positive cytology specimens were uncovered 
in 1963 among 9,275 women examined in the general 
hospital cytology program of the New York State 
Department of Health. Additional funds have been 
allotted to support hospitals carrying out this program 
in 1964. 

Ten of the definite cancers were diagnosed as cari- 
noma in situ, indicating that at least one-third of the 
cases detected had been unsuspected by patient and 

The Pennsylvania Department of Health, aided by 
a $120,000 Public Health Service grant for a 3-year 
program, plans demonstrations in all health regions of 
the State to show dentists and physicians how to un- 
cover mouth cancers in the early stage. The tools will 
be a glass slide and a wood scraper. 

Cancer of the oral cavity and pharynx was responsi- 
ble for 419 deaths in 1963 in Pennsylvania. — Public 
Health Reports 79(10): 924, October 1964. 


Cancer, for some time the leading fatal disease in 
the age group 1-14 years, is now responsible for more 
than one-fifth of all deaths from disease in that age 
group.— Public Health Reports 79(10): 924, October 


The U.S. Government has made three further gifts 
to WHO totalling $1,350,000. The largest single 
amount, $1,000,000. goes to the WHO Malaria Eradi- 
cation Special Account, and contributions of $200,000 
and $150,000 are made respectively to the Special Ac- 
count for Community Water Supply and the Special 
Account for Medical Research. 

Through WHO's world-wide malaria eradication 
campaign large areas have already been freed from 
the disease and the programme is now going forward 
in 85 countries with a total population of more than 
740,000,000. With the latest gift, the total of U.S. 
contributions to the WHO malaria campaign reaches 

The U.S. gift to medical research brings the total 
of its contributions to this part of WHO's work to 
$2,300,000. The medical research programme com- 
prises more than 350 projects in such fields as cancer, 
heart disease, human genetics, and the effects of 
pesticides on man. U.S. contributions to the WHO Spe- 
cial Account for Community Water Supply now total 
$975.000.— WHO Chronicle 18(3): 103, March 1964. 


The New Jersey State Department of Health, with 
funds available from the Public Health Service, has 
contracted to pay the National Travelers Aid Associa- 
tion $11,000 for the period May 1, 1964 to May 1, 
1965 to add services designed to protect the health of 
migrant agricultural workers in New Jersey and after 
they leave the state. 

The association has agreed to provide a caseworker 
and a mobile unit for visiting labor camps, hospitals, 
and other locations; to assure continuity of planning 
for the migrant workers throughout the country, 
through use of the association's offices; and to encour- 
age eft'ective relationships among all groups serving the 
migrant and his family. — Public Health Reports 
79(10): 924, October 1964. 


in a project of the Hawaii Department of Heahh's 
mental retardation division, former residents of an 
institution for the mentally retarded meet once a week 
for i Vi hours with Dr. Setsu Furuno, the chief psy- 
chologist. They learn about community facilities, ven- 
tilate feelings of isolation and loneliness, and discuss 
their problems and satisfactions in relations with their 
employers and families. 

Dr. Furuno has arranged for a special YWCA class 
in sewing for the women dischargees in the hope that 
"they will seek out other recreational and skill programs 
on their own."— Public Health Reports 79(10): 924, 
October 1964. 





Existing regulations require that all Bureau and office mailing lists be cliecked and circularized once each 
year in order to eliminate erroneous and duplicate mailings. 

It is, therefore, requested that EACH RECIPIENT of the U. S. Navy Medical News Letter (Except U. S. 
Navy and Naval Reserve personnel on ACTIVE DUTY and U. S. Navy Ships and Stations) fill in and for- 
ward immediately the form appearing below if continuation on the distribution list is desired. However, all re- 
cipients. Regular and Reserve, are responsible for forwarding changes of address as they occur. 

Failure to reply to the address given below by 15 February 1965 will automatically cause your name to be re- 
moved from the files. If you are in an Armed Service other than Navy, please state whether Regular, Reserve, or 

Also, PLEASE PRINT LEGIBLY. If names and addresses cannot be deciphered, it is impossible to maintain 
correct listings. 

— Editor 

(Detach here) 

Commanding Officer, U. S. Naval Medical School __^ _ _ 

National Naval Medical Center (date) 

Bethesda, Md., 20014 
{Attn: Addressograph Office) 

1 wish to continue to receive the U. S. Navy Medical News Letter. 


Activity ^_ _^ -^ I^et 

or (Print or type, last name first) (rank, service, corps) 

Civilian Status 


(number) (street) 
City - __^ Zone ^ State 











PERMIT NO. 1048